Anti-nicotine zealots chose safety as their main battleground on e-cigarettes, and it didn’t work out too well for them. Now they seem to be doing the same again with Heat not Burn. Will it be more effective this time? Probably not.

We’ve already seen a lot of research from PMI on the safety of their iQOS device. Now British American Tobacco have released their own work on Glo, which is currently on sale in Japan and South Korea. Glo works on the same concept as iQOS, delivering vapour from heated tobacco that’s held in a cigarette-like stick, and the only real difference in the technology is that Glo heats its sticks to a lower temperature. That means we wouldn’t expect to see a huge difference in its vapour compared to iQOS – and, sure enough, we don’t.

Science and smoking

What BAT were interested in was the potential of Glo vapour to cause DNA changes in human cells. Damage to DNA can kill a cell – but, even worse, it can also cause cancer by making the cell grow and divide abnormally. Smoking is known to cause damage to thousands of genes; the question is, how does Glo compare?

Recently there’s been a lot of criticism of studies that use human cell cultures to measure the effects of e-cigarette vapour. This criticism is well aimed, because while the cells might be the same as the ones in a real human body, they don’t benefit from all the body’s layers of defence systems and repair capabilities. In a living body, damaged cells are quickly repaired or ejected; this doesn’t happen in a petri dish.

For their own trials BAT decided they could do better than that. Instead of a simple culture they used an actual simulation of a human airway. Known as MucilAir, it’s grown in a laboratory from cloned human cells and it replicates the body’s own defence mechanisms. The culture can produce mucus, to clear away contamination, and is covered in hair-like cilia like the ones human airways use to expel dust and particulates.

With the experimental tissues set up, BAT’s scientists then programmed a smoking machine to mimic the way people actually use Glo. This is another frequent problem with research into reduced-risk tobacco products – researchers set up their equipment to work in unrealistic ways. Several studies on e-cigs have turned out worthless because the machinery took puffs that were too long and too close together, producing dry hits and high levels of toxic substances that no real vaper would ever experience.

To carry out the actual experiment the machine produced vapour from the Glo and exposed the cells to it continuously for one hour; as a control, a second sample was exposed to smoke from a standard cigarette. Then, 24 hours after the experiment, cells were harvested and broken down to extract their DNA; which was then examined for changes. The process was repeated after another 24 hours to check for damage that took longer to show up. Then the results for Glo were compared with those for the cigarette.

Does Glo cause cancer?

The difference was dramatic. After 24 hours cigarette smoke had caused observable changes in 2,206 genes; Glo vapour had affected one. By 48 hours 2,727 genes were showing a reaction to the smoke, while all genes from the Glo sample were normal. After the researchers adjusted the figures to get a worst-case scenario Glo was still only affecting two genes, while smoke affected 2.809.

It’s obvious from this that Glo’s heated tobacco vapour has much less effect on DNA than cigarette smoke does – in fact, it would be interesting to see a comparison between Glo vapour and city air. So why are BAT insisting that “these results do not necessarily mean this product is less harmful than other tobacco products”? The reality is that’s exactly what these results mean, but heat not burn is in a complicated legal position just now. Philip Morris are still hoping their iQOS will be classed as a reduced risk product by the US FDA, which would allow them to advertise it as less harmful; Glo hasn’t reached that stage yet. Until it does we can expect BAT to be very cautious about what they say, to avoid any damaging legal challenges.

The reality, however, is that this is great news for heat not burn. The gene changes caused by cigarette smoke are known to be linked to lung cancer, as well as fibrosis and inflammation of lung tissue. The new research – which has been peer reviewed, and will be published in the medical journal Scientific Reports – shows that Glo is not causing these changes.

While the health effects of cigarettes are complicated, some things are quite simple. If Glo isn’t causing the gene changes that lead to cancer, it’s not going to give you that type of cancer. That doesn’t mean there are no health risks at all – we can’t say that about anything – but what we can say is that many of the ways cigarettes cause cancer just aren’t possible with Glo.

Earlier research into Glo shows that levels of toxic substances in the vapour are between 90% and 95% lower than in cigarette smoke. That fits together well with the new study. There isn’t a simple relationship between levels of a chemical and the effects it has. Some people make wild claims, such as “There’s no safe level of cigarette smoke!”, but the truth is there’s a safe level of anything. There’s a safe level for things like cyanide and arsenic. It might be a very low safe level, but it exists.

We’re probably fine

My guess – and it is a guess, but a reasonably informed one – is that the level of toxic chemicals in Glo vapour is low enough that it’s below the threshold where it’s going to do any harm. It seems reasonable to believe, based on the evidence we have so far, that using Glo or a similar product is going to eliminate most of the risks of smoking. Common sense backs this up; it isn’t nicotine or even tobacco that kills smokers – it’s smoke. Glo isn’t producing any smoke, so it’s sensible to assume we’re not going to see the same problems.

The last thing to say about this research is that it’s going to be attacked because of who carried it out. We’ve seen that already with research on iQOS, just because PMI paid for it – they didn’t even do the work themselves. BAT have tested Glo in their own labs, but they’ve handed over the data for peer review and it’s been approved of by experts. That won’t stop people attacking it, but they’ll attack the source because they can’t attack the data itself. So far the science is looking good for heated tobacco products, and that’s what counts.

Reviewing new Heat not Burn products isn’t exactly a high-pressure job. It’s not like e-cigs, where there are dozens of new devices and liquids every week. In fact there are only a handful of mainstream HnB systems right now, although the number is slowly growing as the technology becomes more popular. Still, it’s an exciting event when something new appears, so I was pleasantly surprised when an iBuddy i1 turned up in my mail last week.

The iBuddy is a stick-type device, the same concept as iQOS and Glo. Maybe more importantly, it’s also a sign that Chinese companies are taking an interest in HnB. Most of the products we’ve looked at so far are made by the tobacco industry or companies who’ve been making loose leaf vaporisers for a long time, but this one isn’t. iBuddy is a Chinese company based in Shenzhen, the province that’s home to most of the big vaping manufacturers, and so far they’ve mostly made e-cigs. Now they’ve branched out into heated tobacco products.

Earlier iBuddy products look like clones of popular e-cig models, but that’s not the case with the i1. This is an original design, and while the concept is familiar the device is totally new. It doesn’t look anything like either Glo or iQOS, although it has a lot in common with them. Because it’s an independent product it also hasn’t gone through the usual years-long evaluation and test market process that its rivals have; you can simply order one from China and it’ll turn up in the post.

The other interesting thing about this device is the tobacco sticks it uses. iBuddy have, sensibly, decided not to develop their own sticks. That would cost money, and setting up a distribution network would cost even more. Instead they’ve designed the i1 to use PMI’s Heets, which are already available in many countries. PMI probably won’t be too upset by that, either; if someone buys an iBuddy they’re not buying an iQOS, but they will be buying Heets.

Would anyone actually buy an iBuddy instead of the PMI device, though? Good question! Let’s have a look at it.

The Review

The iBuddy is nicely presented, in a solid box with two plastic trays inside. The top one contains the device itself. This is a bit longer than an 18650 battery and fits neatly in the hand. It’s very light, and seems to be mostly plastic, but it feels fairly solid. The front and back have a rubberised anti-slip finish that gives the device more of a quality feel. It’s quite simple, too. There’s a metal button on one side, and a plastic slide at the other. A row of three small LEDs on the front show battery charge and heating status, there’s a hole at the top to take a Heet, and a micro-USB charging port at the bottom. According to iBuddy the built-in battery has a 1,800mAh capacity, and its performance suggests it certainly isn’t any lower than that.

Under the device is a comprehensive instruction booklet, and below that is another tray that contains a USB cable, cleaning brush and some alcohol-soaked cotton buds. That’s it for the package contents, but then apart from a box of Heets it’s all you need.

Plugging it in lit up all three LEDs, showing that the battery was already fully charged or close to it. I left it for a while just to top it off, then opened a fresh pack of Amber Heets and started playing.

The first difference I noticed is the way the device is loaded. With both iQOS and Glo – and apparently KT&G’s new Lil, although we haven’t been able to get our hands on one yet – the stick is loaded straight into a fixed chamber. The iBuddy has a removable holder that can be ejected by pushing up the slide on the side of the device. You don’t have to take it out to load or remove a stick, but I’ll come back to that. I found that the easiest way to load a Heet is to leave the holder in place and insert the stick. They go in easily, with just a little resistance for the last half inch.

To use the iBuddy you just have to press the button to wake it from standby, then hold it down for three seconds to start the heating process. The right-hand LED starts blinking red to show that the heater is running; when it stops blinking and glows a steady red, it’s ready to vape. It heats up quickly – I timed several sticks, and they were all ready to go in under twenty seconds.

So, with the tobacco heated, it was time to take a puff. The iBuddy might be a lightweight device, but the heating element and airflow certainly seem to be up to scratch. With Amber Heets it delivered a satisfying amount of vapour; I would say it’s competitive with iQOS and Glo. The heater is controlled by a puff sensor that allows 16 puffs on a Heet, then shuts down; the LEDs blink as a warning that you have a few seconds left to snatch a last puff. Once the heater switches off the iBuddy will quickly go back into standby.

It was at this point that I found out why the iBuddy has a removable Heet holder. When I’d finished the first stick I just pulled it straight out, which works fine with similar devices. A while later I tried to load a new Heet, and it wouldn’t go in. This was a puzzle, but then I happened to notice something odd about the first one. Imagine my surprise when I realised I was holding a filter and empty paper tube. The contents were still in the holder; once I’d ejected it I was able to get the tobacco out by blowing through the hole at the bottom.

Examining the roll of tobacco, and then shining a light into the hole in the device, soon gave an explanation. The iQOS heats the tobacco with a blade that pierces the end of the roll; the iBuddy has a spike. It’s a fairly substantial spike, which probably helps the performance, but it also gets a good grip on the tobacco and doesn’t really want to let go. If you just grab a used Heet by the filter and pull it out, more often than not the tobacco will stay on the spike. Ejecting the holder helps, but it’s not infallible – the tobacco still stays in the holder at least once every five or six sticks. This isn’t a massive issue, but it is a bit annoying – especially when you blow a roll out of the holder and it disintegrates, spraying strands of tobacco all over your keyboard.

Despite this problem I was able to give the iBuddy an extensive trial, using it for several days – including one day when I didn’t use anything else – and it does the job. The vapour is satisfying, and battery life is good – better than iQOS, and similar to Glo. After using a full pack of twenty Heets on a single charge, one of the three LEDs was still lit, showing more than 25% charge remaining; I’d say that, unless you’re a very heavy user, you should be able to get a full day’s vaping out of a full battery.

The Verdict

Given the choice, would I personally take the iBuddy over an iQOS? No, probably not. That’s mainly down to the bother of having to clear tobacco out of it every few sticks. It does get irritating, and for me the superior battery life doesn’t quite compensate for that. It also feels a lot less robust overall; it’s so light that I’m pretty sure the whole body is made of plastic, and it just doesn’t have the solidity of its competitors. It’s by no means a bad device though, and it does have another advantage – price.

Officially the iBuddy i1 sells for $69.99, but you can find it online for $45.99 – a bit under £35. An iQOS is going to cost around twice that. If you’re on a tight budget, or want to try Heat not Burn without investing in an iQOS just yet, the iBuddy could be what you’re looking for.

Yesterday was an important day for PMI’s iQOS device, and for the whole future of Heat not Burn in the USA. Following a long bureaucratic process an FDA advisory panel discussed, then voted on, PMI’s claim that iQOS is a Modified Risk Tobacco Product (MRTP), a decision that could decide whether or not it goes on sale in the United States. It went better than it might have done, but unfortunately the results were still disappointing.

PMI submitted their MRTP application in December 2016; the reason it’s taken so long to come to a vote is that the application came to over a million pages of data. Achieving MRTP status would be a significant advantage for iQOS; it would allow PMI to market the product as less harmful than cigarettes, and to alter the warning labels on packaging to make clear that it’s a safer alternative. The final decision on granting MRTP status will be made by senior FDA management, probably some time in the next few months – and, while they’re free to ignore the recommendations of the advisory panel, they rarely do.

What was decided?

Yesterday’s panel voted on three issues. Firstly, have PMI proven that switching to iQOS will cut the risk of developing a smoking related disease? Secondly, is using iQOS healthier than continuing to smoke? Finally, does switching to iQOS reduce exposure to harmful and potentially harmful chemicals? In a slightly confusing mixed decision the panel rejected the first two claims, but voted strongly in favour of the third.

On the first question, reducing the risk of smoking-related disease, eight of the panel’s nine members voted that PMI hadn’t provided evidence for this; the last member abstained. The main issue seems to be that most of PMI’s clinical testing was carried out on rats, and the panel want to see results from human tests. To be blunt about it, this is not very reasonable. iQOS is a relatively new product, so there hasn’t been time for long-term trials on humans.

However, when it comes to the chemicals involved in iQOS vapour, this isn’t exactly a leap into the scientific unknown. All the potentially harmful substances found in iQOS vapour are also found, at much higher levels, in cigarette smoke – and of course the most harmful ingredients of smoke, carbon monoxide and tar, aren’t found at all.

On its own the panel’s rejection of this claim isn’t too surprising, although it’s certainly not justifiable. The FDA has a huge institutional hostility to tobacco products; even Swedish snus, which appears to pose no health risks at all, hasn’t been able to make its way through the MRTP process yet. However, put the decision into context with the FDA’s finding that PMI are right about iQOS users being exposed to fewer, and less abundant, toxins and it makes no sense at all. After all, it’s exposure to these chemicals that causes smoking-related disease, so if the chemicals are reduced or eliminated the risk of disease will fall. That’s basic toxicology – “The dose makes the poison”. This isn’t exactly a radical idea either; it’s been universally accepted since Paracelsus wrote it in 1538.

Exactly the same applies to the panel’s decision that using iQOS hasn’t been proven healthier than continuing to smoke. If they accept that the vapour is far less toxic than cigarette smoke – and they did, by eight votes to one – then why not also accept that inhaling vapour is much less risky than inhaling smoke?

So what’s going on?

On the face of it the panel rejecting two of PMI’s claims, but accepting a third that backs up the first two, doesn’t make any sense. After all the reduction in harmful chemicals is the whole point of iQOS, and the reason behind it is to reduce risks.

It does start to make sense if you look at it from an ideological, rather than a scientific, perspective. The panel can’t really argue with the fact that iQOS vapour has a fraction of the problematic chemicals found in tobacco smoke; that’s hard data, collected by independent labs and published in peer-reviewed journals. It cannot be disputed. Denying it is equivalent to Flat Earthism, so it’s actually impressive that only one member of the panel went down that road.

On the other hand, the claims about reduced risks to health are tentative. They’re based on the best analysis of the data, but – hypothetically, at least – they could be wrong. They aren’t, of course; that would require what tobacco control expert Clive Bates called “a novel and implausible theory of the human body”. But, nevertheless, the panel seem to have seized the chance to show how much they hate the tobacco industry.

Now what?

As annoying as it is, the panel’s conclusions aren’t the end of the road for iQOS. When the FDA makes its final decision there are still two open questions. One is whether or not to grant MRTP status anyway, despite the vote. Recommendations from the advisory panel carry a lot of weight, but the agency can disregard them. It’s definitely possible that under director Scott Gottlieb, who at least on paper is committed to harm reduction, they’ll decide to grant it.

Even if they don’t award MRTP, the FDA can decide to let iQOS go on sale anyway. In that scenario the packaging would have to carry standard health warnings and PMI wouldn’t be able to market it as a safer option, but word would get round anyway and we could expect to see a lot of smokers make the switch. iQOS is demolishing the cigarette market in Japan at an impressive rate and there’s no reason why it couldn’t do the same in the USA; it would be hard for even the USA to object to that.

The worst case scenario is that Gottlieb decides not to allow iQOS to be sold in the USA. That seems unlikely, but if it does happen the result is likely to be disastrous for HnB in America. PMI have spent a vast amount of money preparing this application, and if it’s rejected on openly ideological grounds it’s hard to see other companies lining up to apply. There’s a lot of lives hanging on the FA’s decision, so let’s hope that unlike their advisory panel they get it right.

In the last post we talked about New Year resolutions and how switching to heated tobacco might be one of yours. That turned out to be quite prophetic, because somebody else made a resolution that features HnB products, and they didn’t exactly keep it quiet either. That somebody was Philip Morris, the world’s largest and most successful tobacco company, and they announced their resolution with a series of full-page ads in major newspapers.

On the 2nd of January, a large PMI advert appeared in three of the UK’s best-selling papers, The Times, The Sun and The Daily Mirror. To say it was attention-grabbing doesn’t really do it justice. The banner headline read:

OUR NEW YEAR’S RESOLUTION

WE’RE TRYING TO GIVE UP CIGARETTES

Just to make sure everyone got the message there was a big, bold PMI logo at the bottom of the ad, which certainly must have piqued a lot of people’s interest. After all, PMI are pretty much famous for one thing, and that thing is selling cigarettes. So why on Earth would they want to give them up?

If you read on, you’ll find out. The next line says “Philip Morris is known for cigarettes. Every year, many smokers give them up. Now it’s our turn.” That doesn’t leave a lot of room for doubt – PMI are saying, very clearly, that they want to stop selling cigarettes.

Predictably, this has sparked a lot of comments. Many people are very supportive – we at Heat not Burn UK are, for example. So are most libertarians, many vaping advocates and at least one major tobacco control group, the Foundation for a Smoke-Free World.

Equally predictably, not everyone is so happy. A whole alphabet of agencies, pressure groups and nanny state advocates are jumping up and down, squeaking in outrage. How very dare Philip Morris say they’re going to stop selling cigarettes! Isn’t it awful that they’re allowed to say such horrible things?

Well, maybe not. Let’s look at exactly what PMI are proposing, seeing as they helpfully listed it all in their adverts:

Launch a new website, with an associated marketing campaign, to give smokers information on how to quit and what safer alternatives are available.

Offer support to smoking cessation services in areas where smoking rates are highest.

Put a card with information on how to quit or switch to a safer product in packs of cigarettes.

Make more safe alternatives available to British smokers.

Of course PMI have already spent more than £2.5 billion on the last of these, and the first products are on sale in the UK right now – iQOS and the Mesh e-cigarette. Over the next year or two more will follow, including at least one more heated tobacco product and a completely different one that uses chemical reactions to create a nicotine mist.

So what’s the problem? Why are people like Deborah Arnott, the perpetually outraged CEO of Action on Smoking and Health, so angry that PMI are willing to spend a lot of money helping smokers to quit? Well, that’s where it gets complicated. There seem to be two main themes at work here, so let’s look at those.

PMI don’t mean it!

The first objection is that Philip Morris don’t really mean it. After all, if they want to stop selling cigarettes they could just stop, couldn’t they? In fact tobacco control come out with this argument every time a tobacco company does anything related to harm reduction or alternative products – “Why don’t you just stop making cigarettes, then?”

Well, mostly because it’s not that simple. Last Tuesday, when the PMI advert appeared, the BBC asked a company spokesman the same question, and it got an obvious answer: Basically, “Because if we stopped selling cigarettes tomorrow, smokers would just buy them from someone else.”

I suppose you could argue that if all the tobacco companies stopped selling cigarettes there would be nobody else to buy them from, but let’s be realistic here: There’s a large, organised criminal industry making counterfeit cigarettes already, despite the tobacco companies selling over five trillion real ones every year.

Just imagine what would happen if the legitimate supply dried up. Does anyone seriously think all of the world’s one billion smokers would just quit? Not a chance; most of them would start buying on the black market. The people who run that black market would become, overnight, the richest and most powerful criminals in the history of the world. Cocaine, heroin, even America’s Prohibition-era bootleggers would pale into insignificance.

There’s another point, too. Tobacco companies have a legal duty to their shareholders to make a profit, so if they all trashed their businesses tomorrow they’d go to jail. Meanwhile the pension funds who are the biggest owners of tobacco shares would collapse, leaving millions of pensioners in poverty. The economic damage alone could trigger another global recession.

So, for a couple of reasons, PMI can’t just stop making cigarettes. It’s only going to work once the majority of smokers have either quit or switched to reduced risk products, like Heat not Burn or e-cigarettes. Philip Morris have already spent a lot of time and money encouraging that, and now they’re offering to spend more.

It’s against the rules!

Arnott also claims that PMI’s second proposal – offering support to stop smoking services – is illegal. The basis for this claim is that under Article 5.3 of the WHO’s tobacco control treaty, governments aren’t allowed to accept donations from the tobacco industry. This obviously looks like a problem, except for one tiny detail: Somebody is lying here, and it isn’t PMI.

Article 5.3 says no such thing, and Deborah Arnott knows that. All the article actually says is that any interaction between government and the tobacco industry must be transparent, so as long as PMI are supporting stop-smoking services openly there’s no problem. I’ve met Arnott more than once and it would be safe to say she is not my favourite person (I’m not hers, either), but it’s still unpleasant to have to state that she is being completely dishonest here.

Arnott says that, instead of donating to stop smoking services, tobacco companies should be forced to give the government more of their profits. It’s not hard to guess why: ASH has lost a significant amount of its government funding in the last year, and its response has been to push for a Tobacco Levy. This would be an extra tax on the industry, with a big chunk of the proceeds going to – you guessed it! – ASH.

Back to reality

The truth is, it’s not hard to understand why PMI are serious about moving to safer products. Why wouldn’t they be? There’s obviously a demand for safer ways to use nicotine – just look at the way vaping has taken off in the UK, and how fast iQOS is growing in Japan. If PMI don’t sell those products they’ll lose out to companies that do, and if they are selling them, why not work to steer customers towards them and away from the more dangerous ones?

What it comes down to is that smoking isn’t good for you, and everyone knows that. The tobacco companies know it, although they denied it once – but that was decades ago and the people who did it are all long gone. Arnott knows it; after all, she’s made a lot of money telling people. You know it, too; that’s why you’re on this site reading about safer products.

Heated tobacco, and other reduced-risk products like e-cigarettes, have turned the world of tobacco control upside down. Now we have Philip Morris offering to spend their own money to help people quit smoking, while the old guard like Deborah Arnott shout abuse from the sidelines because it’s not all about them anymore. At Heat not Burn UK we’re just interested in safer alternatives to smoking, and we’re on the side of anyone that makes them available. So well done on your New Year’s resolution, PMI – we’re sure you’ll do all you can to make it happen.

So the first of January is almost here, and most of us will be thinking about New Year resolutions. What are we going to do better in 2018? If you’re a smoker, it’s pretty likely that your resolution is to quit the habit. Every year, about 9% of British adults say their New Year resolution is to quit smoking – that’s more than half of all Britain’s smokers.

The problem is, most of them won’t succeed. In fact most won’t even try very hard to quit smoking because, whatever health campaigners say, most smokers don’t really want to quit. They know they should quit, but that’s not the same as actually wanting to. The truth is, smokers usually enjoy it. They like the taste, they like the effects of nicotine and they like the social aspects of it. For many people the positives outweigh the harm, especially as that’s all uncertain and probably years in the future.

Harm reduction

Obviously, if smokers enjoy the habit and only feel they should quit because of the health risks, there’s a place in the market for something that’s just as enjoyable but doesn’t have the risks. That’s why e-cigarettes have grown so quickly; a quarter of British smokers have now started vaping, and more than half of those have switched completely.

The problem is, vaping doesn’t work for everyone. Some ex-smokers like the variety of flavours you can get, but others want something that tastes like their favourite cigarette – and there’s no way to do that with an e-cig. It just isn’t possible to recreate the flavour of burned tobacco. The devices can also be quite fiddly, especially if you want good performance. The best e-cigs need a bit of work to get the coils set up properly and the liquid blended to your taste. Even the simplest ones aren’t quite as simple as smoking.

That’s where Heat not Burn comes in. Because HnB products use actual tobacco, instead of a flavoured liquid, they can get much closer to the taste of a real cigarette. The tobacco isn’t actually burned, of course, but it’s still heated enough to recreate the flavour very closely. The latest HnB devices are also very simple to use – sometimes exactly the same as a cigarette; you just take one out the pack and light the end.

So HnB can match the taste, sensation and convenience of smoking, but how does it stack up in terms of health? There’s been a lot of debate about that, because the products are so new, but this year we’ve seen some data starting to appear – and it’s all looking like good news.

How safe is HnB?

It isn’t nicotine that causes the health problems associated with smoking. It isn’t really tobacco, either. It’s smoke. When you burn something you create a whole list of toxic by-products. If it doesn’t burn with perfect efficiency – which is almost never will – the worst chemical that gets created is carbon monoxide. This is what causes almost all the heart disease in smokers.

As well as carbon monoxide, burning tobacco produces tar. This isn’t the same as the tar that goes on the roads, but it’s close enough – dark, sticky and oily. Tiny droplets of it boil off from the burning tobacco and condense in your lungs. Unfortunately, tar is riddled with chemicals that cause cancer and other lung diseases.

Tar and carbon monoxide are both bad for you, but there’s something else they have in common and you probably spotted it – they’re produced by burning. With Heat not Burn the clue is in the name – they don’t burn anything. That means there’s no tar and no carbon monoxide – and, right away, most of the danger of smoking is eliminated.

You’ll hear people say that, because HnB products are so new, there’s no way to know how safe they are – and they might be even worse than cigarettes. That simply isn’t true. Science has come a long way in the 140 years since modern cigarettes were invented, and the vapour from the latest HnB devices has already been very thoroughly studied. Right now, experts are saying that it’s about as safe as e-cigarette vapour, and the best estimate is that e-cigs are at least 95% safer than smoking.

Does it work?

So HnB is very similar to smoking, but a lot safer. But does it really work as an alternative? Yes it does. The most popular device right now is PMI’s iQOS, which was released in the UK just over a year ago. It’s been on sale in Japan for nearly two years – and it’s already made a huge difference to smoking rates. In the first half of this year alone cigarette sales fell by 11%, as millions of smokers switched to HnB. That figure is probably a lot higher by now, and PMI are saying that over 70% of Japanese smokers who’ve tried iQOS have quit smoking by completely switching to it.

Heat not Burn has been tried before, but it’s never really worked out. Two things have changed that. One is that, thanks to vaping, most smokers are now more willing to at least try an alternative; the other is that the technology is just better now. iQOS really works, and BAT’s rival Glo is likely to appear in British shops next year. There are other new products on the way, too. Before long there will be a range of HnB options for any smoker who wants them.

There’s no doubt that quitting smoking is one of the best things you can do for your health, but for most smokers it’s not easy; they struggle to quit, most will fail, and even those who succeed are likely to miss it. If you’ve decided to make quitting your New Year resolution for 2018, but you’re not really looking forward to the attempt, maybe it’s time to try something smarter. Instead of putting yourself through the misery of withdrawal, go for a solution that lets you keep the positive aspects of smoking but eliminate almost all the risk.

Quitting is hard; switching to Heat not Burn is easy, because you’re not really giving anything up. If you think it’s time to stop smoking, but you’re not exactly bursting with enthusiasm at the thought, grab yourself an iQOS starter kit and get started. Don’t quit – upgrade!

A couple of weeks ago I mentioned that the next device we looked at on Heat not Burn UK would be the PAX 3 from Pax Labs. That’s sparked some excitement from just about everyone I know who’s ever used a loose-leaf vaporiser to inhale anything, which didn’t really come as a surprise. After all, if there’s a device that every other vaporiser on the market ends up being measured against, the PAX 3 is it.

This gadget is the follow-on to the already legendary PAX 2, and it follows the same basic principles. There are some significant upgrades, though, including improved battery life and better software. It also adds the ability to use wax concentrates, but that isn’t something we’ll be looking at – our only interest in the device is how good it is for vaping tobacco.

Last month we reviewed the Vapour 2 Pro Series 7, which works on the same principle as the PAX 3; it has an internal chamber that you can load up with tobacco, and when you power it up the contents of the chamber get heated enough to release a vapour that you can inhale. It doesn’t get heated enough to actually burn the tobacco, so you avoid all the tar, carbon monoxide and other assorted cag that cigarettes create.

Although the basic principle is the same as the Series 7, the PAX 3 has a few major differences in how it’s laid out. In fact, while the Series 7 turned out to be pretty impressive after I figured out how to use it, the PAX feels like it’s in a whole different class. The question is, did its performance measure up? Let’s find out.

The Review

I think I mentioned in one of my videos that HnB products tend to come in really nice boxes. Well, the PAX 3 takes that to a whole new level. This is the nicest box I’ve seen for any kind of vaporiser. In fact it’s probably the nicest box I’ve ever seen for anything that didn’t come from a jeweller’s shop and cost a month’s wages.

The usual cardboard sleeve slides off to reveal a box that opens like a book, revealing two fold-out covers. One has a discreet Pax logo in the middle; the other side says, equally discreetly, “Accessories”. The two halves of the box don’t flap about, by the way. They stay respectably closed, although there aren’t any visible magnets. I investigated with a magnetic field detector (I have some odd stuff) and, sure enough, there are two small but powerful magnets actually embedded in the sides of the box.

Desperate to get to the good stuff, I opened the flap with the Pax logo and there was the vaporiser, sitting all alone in a little cut-out. It’s much simpler than the Vapour 2 Pro, bordering on minimalist; the body is a single piece of anodised aluminium, polished to a glassy finish, with a rubber top cap and plastic base. It’s slightly chunkier than the PAX 2 but still very compact and slim. There are no visible controls; on the front there’s just a Pax logo illuminated by four LEDs; on the back you’ll find two brass contacts, the device name and serial number.

It turns out the only control is under the rubber top cap, which also serves as a mouthpiece; to turn it on you just press down on the centre of the cap until the Pax logo lights up. Holding the button for two seconds opens the temperature select mode. There are four temperature options; press the button to cycle through them, and the petals on the logo light up one by one to show how hot it will get.

The plastic bottom cap covers the heating chamber; just press one side of it and it pops out. The chamber itself looks slightly smaller than the Vapour 2 Pro’s, and there’s a replaceable metal screen at the bottom to keep tobacco out of the device’s innards.

The PAX 3 is beautifully made; there’s no other words for it. The finish is perfect (although a bit of a fingerprint magnet) and everything fits together immaculately. It’s also very light – lighter than the Vapour 2 Pro or any e-cig I own – but feels strong and solid. A definite ten out of ten for workmanship.

Anyway, as I took the vaporiser out, I noticed that the card around it was loose. Removing that, I found it concealed two more items – the charger and USB cable. The charger is a simple cradle that you lay the device on, and magnets will line the contacts up correctly. It’s very simple to use, and should also be well sealed and robust.

The other side of the box has lots of stuff in it, and some of it’s not too obvious at first. There’s a card on top, giving instructions on how to register the device and download the Pax app (do both). Then, underneath, is an assortment of bits and pieces. A white pad conceals the tiny instruction manual, which you should definitely read. There’s a key ring, which turns out to be a simple multitool; its rubber body is for tamping leaves into the heating chamber, and the inlaid metal strip with the Pax logo is a cleaning tool. A box marked “Maintenance kit” holds some pipe cleaners and a brush.

Next, there’s another mouthpiece and two bases. The standard mouthpiece is flat, with a slot at one side for the vapour. The spare one is raised, if you prefer that shape. There’s also a base with an inner chamber for wax concentrates, which we won’t bother with, and a second dry herb one with an insert to let you half-fill the chamber. That might be important for certain herbs, but it isn’t with tobacco – the chamber isn’t huge. So we won’t bother with that one either. Finally, you get three spare screens for the heating chamber and an extra O-ring for the concentrate chamber.

The next step was to charge the battery, which was easy and only took a couple of hours. The charger really is easy to use, and the Pax logo shows how the battery’s doing. The four “petals” of the logo will pulse white and progressively light up as the charge rises, and glow solidly when it hits 100%.

So, back to how it works. As you might have guessed, the heating chamber and mouthpiece are at opposite ends on the PAX 3. To load the chamber you remove the bottom cap, load your tobacco and put the cap back on. A narrow tube runs through the body and opens into a small chamber just under the mouthpiece. This arrangement lets the vapour cool down before you inhale it; apparently this helps when you’re vaping herbs, but I’m not sure it’s so necessary with tobacco.

Right, on to the test! I loaded the chamber with tobacco from a fresh pouch, taking care not to pack it too tightly, then activated the PAX 3. This is easy; just press the button – don’t hold; just press. Instantly the LEDs in the logo flash white, then turn purple – when they’re purple that means the PAX is heating up. And it heats up fast. Even with the temperature set to maximum the logo turned from purple to green in less than 25 seconds, and that was it ready to go. All that was left was to start vaping it.

This is where things get a bit mixed. Here’s the good news: With the temperature set at maximum, the vapour from the PAX 3 is the best I’ve found from any Heat not Burn device so far. There’s plenty of it and the taste is great. After one puff I was extremely impressed. After the second I was pretty much ecstatic. Then it started to go downhill.

The third puff gave almost no vapour at all, and the next couple were the same. There was still a faint taste, but it wasn’t very satisfying. At this point I put the device down and let it sit for a moment to build up vapour, then tried again. By doing that I got a couple more reasonable puffs out of it, but then it dried up for good.

Unlike the Vapour 2 Pro the PAX 3 doesn’t automatically cut off after a set time; you have to switch it off using the button (it will turn off if it’s left untouched for three minutes). So I turned it off, let it cool down, emptied the chamber (the cleaning tool works very well) and had a poke at the tobacco. It was bone dry, so my guess is that it stopped producing vapour because there was nothing left to evaporate.

What I think is happening is that the PAX 3 is a victim of its own success. The design of the heating chamber is obviously great. It’s very efficient, probably because of its shape – it’s quite long and narrow, so the contents heat up very quickly and evenly. That means the first couple of puffs are great. The problem is, the first couple of puffs basically contain all the moisture in the tobacco. I also tried it on a lower temperature setting, but this radically dropped the quality of the first puffs and didn’t really extend the session by much; you might get five puffs instead of two, but they were nowhere near as good.

If you’re trying to replicate the experience of smoking this is a bit of a drawback. You can expect to get about ten good puffs from a cigarette, but you’re going to have to reload the PAX 3 four or five times to match that.

Conclusion

From everything I’ve heard about the PAX 3, it’s unrivalled as a device for vaping substances of a more herbal nature – but, for tobacco, it doesn’t have the same edge. It’s a beautifully made device with good battery life (it packs in 3,500mAh, compared to the PAX 2’s 3,000mAh), and it’s simple to use, but if you’re mainly interested in tobacco I don’t think it’s the best option. If you really want a loose-leaf tobacco vaporiser the Vapour 2 is at least as good and a lot cheaper; if convenience and performance are what matters most, go for an iQOS.

So we’re into the last month of 2017 and the end of the year is approaching fast. Christmas is three weeks away, and it’s likely quite a few smokers will be finding an iQOS starter kit under the tree as friends and family try to nudge them in a safer direction. Well, it might be a few smokers – or it might be a lot of smokers. Because 2017 has been a big year for Heat not Burn.

A lot has changed in the reduced-harm tobacco market since January. We’ve seen new products appear, and existing ones rolled out to wider audiences. HnB has started to attract attention from health researchers and lawmakers – which isn’t always a good thing, of course, but it’s an inevitable part of getting the products on sale. So, as Christmas decorations go up and the snow comes down, let’s have a look back at what 2017 has meant for Heat not Burn.

iQOS goes global

When iQOS was first released it was only available in a few test markets, but towards the end of 2016 it began appearing more widely. The UK’s first iQOS store opened in December 2016, and there are now three in London. Last year the product was almost unheard of, but now it’s becoming much better known.

The big challenge for iQOS is the US market. Before it can go on sale it has to be licensed by the Food and Drug Administration, and in March Philip Morris submitted the paperwork to have iQOS classed as a “Modified Risk Tobacco Product”. That application hasn’t been approved yet, but hopefully it should be decided next year. If the FDA approve it – and it’s hard to see how they can refuse – expect iQOS to be a big hit among US smokers.

Meanwhile, the statistics coming out of Japan show just how much potential iQOS has. PMI say they can’t keep up with demand, and every new batch they deliver sells out right away. iQOS really seems to have made an impression – and cigarette sales in Japan fell by an astonishing 11% in the first six months of this year, as smokers moved to HnB.

The growth of Glo

So far iQOS doesn’t have any serious rivals as a mainstream HnB product, but that’s likely to change soon. BAT’s competing Glo was launched in Japan last year; now the market testing has been expanded to South Korea, and next year we can expect it to start hitting other countries. The UK is a likely candidate, thanks to a generally positive attitude to reduced-risk products; BAT will also want to build a presence before iQOS becomes too firmly established as the market leader.

Glo is also the product we have most hands-on experience with at Heat not Burn UK – we did the first UK review of the product a few months ago, following a sneak preview back in February when Dick Puddlecote managed to get his hands on one. That experience was pretty convincing – Glo has a lot of potential, and we think smokers are going to like it when it hits the UK shelves.

Heat not Burn UK visits PMI

In April we were offered the chance to send someone to PMI’s research facility at The Cube in Neuchatel, Switzerland, to see what progress is being made on HnB. This gave us a chance to look at the latest science on the safety of iQOS, which is very encouraging, as well as seeing how HEETs are made in the Neuchatel factory.

What really encouraged us is that PMI aren’t just pinning all their hopes on a single product. They know that electronic devices like iQOS (or e-cigarettes) don’t work for everyone – they’re not a lot of use for people who spend long periods working outdoors or at sea, for example – so they’re working on four separate non-cigarette devices. These include a charcoal-heated cigarette and a device that creates nicotine vapour through a chemical reaction, as well as iQOS and the Mesh e-cigarette.

Lil joins the race

South Korea is a popular test market for HnB products, with iQOS and Glo both going on sale there early in their careers. Now the country’s own industries are waking up to the possibilities. Korean Tobacco & Ginseng have developed their own device, the Lil, which also heats tobacco sticks to create a vapour.

Lil is on limited release in South Korea just now, but should be rolled out across the country quite soon. The question is whether KT&G plan to market it globally. So far they haven’t announced any plans, but H&B isn’t a crowded market right now. This would be a huge opportunity for them to build a global presence.

We’ve contacted KT&G to ask if we can have a Lil for review, but haven’t heard back from them yet. Hopefully we’ll have some news on that soon, because it’s an interesting-looking device and we think it deserves a wide audience.

Looking forward

So this has been an exciting year for Heat not Burn; the technology is making its way into the mainstream, hundreds of millions of people around the world are able to buy the products, and that number is set to grow fast in 2018. If what we’ve seen from Japan is any guide, there’s a possibility that HnB could overtake e-cigarettes as the favourite alternative to smoking within a few years.

In any case, 2017 isn’t quite over yet. There are still a few weeks to go before New Year, and the team at Heat not Burn UK won’t be taking that time off. There will be a video review for the Vapour 2 Pro we’ve been testing for the last month, and we also have a new toy to play with – the PAX 3. This is the latest upgrade of the PAX 2, the most respected loose-leaf vaporiser on the market, and there’s one sitting on the table in HnB UK’s secret headquarters. That will be getting unboxed soon, and tested over the next couple of weeks, so drop in to see what we think of it!

And so it begins. A new paper presented to the American Heart Association claims that Heat not Burn products harm blood vessel function in the same way as smoking. No doubt there are a dozen other studies underway right now that will soon produce papers linking HnB to heart attacks, lung disease and various cancers. Carefully tailored press releases, all including some form of the phrase “as bad as smoking”, will be leaked to sympathetic journalists. Public health activists don’t even need to go looking for friendly hacks; they can just get in touch with the ones who wrote negative articles about e-cigarettes.

If I sound cynical about the new paper, it’s because I am. I switched from smoking to vaping five years ago, just in time to see the tobacco control industry gearing up its campaign against e-cigs. I have to confess that, at the time, I watched it unfold with total incredulity. Here was a product that got smokers to stop smoking, but the activists and scientists who’re always demanding new action to stop smokers from smoking were opposed to it! What the hell was going on?

Well, five years later, I know what’s going on. The tobacco control industry is, in big-picture terms, split between two main factions – and neither of them is really interested in helping smokers to quit. One faction is motivated by a blind, unreasoning hatred of the tobacco companies; if Philip Morris invented a cure for cancer tomorrow, this group would try to have it banned.

The other faction is no fan of the tobacco companies either, but it has different priorities. Its goal isn’t to stop smokers from smoking; it’s to campaign to stop smokers from smoking. Obviously, if all the smokers become vapers or Heat not Burn users, there won’t be any smoking to campaign against – and that means they’ll have to find new jobs, which might involve some actual hard work rather than just being handed taxpayers’ money to complain about things.

Tinfoil hat time?

Claiming that public health campaigners are more worried about their jobs than public health sounds a bit paranoid, but what’s happening in the UK right now tends to back it up. Local councils who’re trying to save money are starting to take a good look at the stop smoking services they fund – and it appears that some of them don’t like what they see. Several services, including Smokefree South West, have had their council funding stopped, and for nanny state groups that’s usually a death blow. Nobody actually wants to give them money, so if the tax tap is turned off that’s the end of them. Smokefree Southwest announced its closure within 24 hours of being defunded.

The reason councils are starting to defund anti-smoking groups is that it’s obvious they aren’t doing anything. Most councillors aren’t daft; they see smokers switching to e-cigs by the thousand, and the UK’s smoking rate falling faster than ever before. Then they see so-called “public health” groups demanding that e-cigs are taxed, restricted and banned out of existence. Finally it occurs to them that not only are these groups not doing anything to reduce smoking; they’re actively campaigning against products that are. So they pull the plug, and another dozen tobacco controllers are forced to get a proper job.

And all this is happening because of e-cigs. Just imagine what’s going to happen when HnB goes mainstream. Personally, I wouldn’t be surprised if a decade from now the UK’s smoking rate has fallen from its current 16% to around 5%. If that happens a lot more tobacco control funding is going to evaporate, which is why all the usual suspects are already moving to condemn HnB.

What does the science say?

Anyway, back to the paper. What exactly is it saying, and should we take it seriously? The short answer is “Not much and no.” That isn’t very informative, though, so let’s look at it in slightly more detail.

The paper was written by the tobacco research department at the University of California, San Francisco. If you follow the vaping debate that’s probably ringing alarm bells already, because who runs UCSF’s tobacco research department? Yep, it’s Stanton Glantz, the failed aircraft engineer who’s managed to get a job as a professor of medicine despite never having studied medicine in his life. The reality is that Glantz is an activist, not an academic, and this department is shaped in his image: Before they even start doing any research, they know exactly what results they plan to get.

What they wanted to find here was evidence that HnB is just as bad for you as smoking. Now, this is obviously a ridiculous idea. Probably the most harmful single ingredient in cigarette smoke is carbon monoxide, which is produced by combustion, and HnB doesn’t involve combustion.

What they actually mean is that one specific effect of HnB is the same as an effect of smoking. That is obviously not the same thing as saying that using HnB is as bad for you as smoking is. In this case they’re talking about something that isn’t really bad for you at all.

The paper claims that using a HnB product – specifically, iQOS – has the same effect on “Flow-Mediated Dilation”, a way of measuring the efficiency of blood vessels, as smoking a cigarette. In general terms this is true; it’s likely (not certain, but we’ll come back to that) that iQOS will cause a similar short-term effect on blood vessels to a cigarette. Where it all comes unstuck is that the authors go on to say that HnB “does not necessarily avoid the adverse cardiovascular effects of smoking cigarettes”. That statement is a massive problem.

Smoking cigarettes is really bad for your heart. Smoking cigarettes also causes short-term stiffness in your arteries every time you light up and take a puff. But these two facts are not connected. It isn’t the short-term stiffness that makes cigarettes bad for your heart; it’s the couple of hundred daily doses of carbon monoxide, which causes long-term stiffness and the build-up of arterial plaque. Many other things also cause short-term stiffness – caffeine, watching scary movies and exercise are among them. It doesn’t matter, though, because it only lasts a few minutes. Smoking is dangerous because it makes your arteries stiffer all the time, plus promote the build-up of plaque which slowly blocks them. iQOS, being free of carbon monoxide, doesn’t do this.

So what’s really going on with this paper? Leading e-cig expert and cardiologist Dr Konstantinos Farsalinos has the answer, as already reported on this site. According to the UCSF paper, the iQOS delivered 4.5 times as much nicotine to the test subjects (who, it should be pointed out, weren’t people – they were mice) as a cigarette did. As nicotine is known to cause temporary stiffening, that would certainly explain the effect. It would also suggest that it’s nothing to worry about. After all, licensed nicotine products like patches and gum cause an identical effect, and they’re sold over the counter and approved for long-term use.

If we take its data at face value, this paper shows that HnB has the same effect on blood vessels as a nicotine patch, which is regarded as very safe – in other words, there’s nothing to worry about. In fact, what the data show is that the researchers have made a very serious mistake somewhere. According to them, iQOS delivers about 350% more nicotine than a cigarette does – but three independent studies all agree that it delivers about 30% less nicotine. As Dr Farsalinos points out, it is impossible for iQOS to deliver that much nicotine. Therefore the UCSF team have screwed up somewhere, and if they’re working on terminally flawed data, that the whole paper can safely be ignored.

Unfortunately, while this one might be (it doesn’t seem to have gained much traction outside crank medical websites), as HnB becomes more popular we can expect to see more “research” being done and negative stories starting to appear in the press. It’s likely that all the smear stories that have been aimed at e-cigs will be recycled to attack HnB too. If you doubt that, consider this: Just two months ago, a paper from Sweden claimed that e-cigs have the same effect on arterial stiffness as smoking does. Sound familiar?

Heat not Burn is going to get exactly the same treatment as vaping did; I guarantee it. In fact, if anything it will be worse, because the leading HnB products actually are made by the dreaded tobacco companies. Vapers couldn’t really believe what was happening at first, and lost a lot of ground to bad science and scaremongering media before advocates started fighting back. If you’re a fan of HnB, don’t make the same mistakes; start pushing back now.